Healthcare Provider Details

I. General information

NPI: 1700685856
Provider Name (Legal Business Name): KEANI HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9281 E OUTER DR
DETROIT MI
48213-4010
US

IV. Provider business mailing address

9281 E OUTER DR
DETROIT MI
48213-4010
US

V. Phone/Fax

Practice location:
  • Phone: 313-721-7855
  • Fax:
Mailing address:
  • Phone: 313-721-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: